Key result
Youth with a history of EV-A71 CNS involvement had three times the odds of receiving an ADHD diagnosis compared to a national sample (34.9% vs 10.1%; 95% CI 1.8-4.2).
Why the study?
No longitudinal prospective clinical study had systematically investigated the consequences of early-life Enterovirus A71 central nervous system infection on the later development of other psychiatric disorders.
Does early-life EV-A71 CNS infection increase the long-term risk of psychiatric disorders in youth?
Cohort (n=43)
Does early-life EV-A71 CNS infection increase the long-term risk of psychiatric disorders in youth?
Odds Ratio: 3 (95% CI 1.8–4.2)
Absolute Event Rate: 34.9% vs 10.1%
Early-life EV-A71 CNS infection is associated with a significantly increased long-term risk of developing ADHD and related neurodevelopmental issues.
EV-A71 CNS involvement was associated with higher ADHD rates; hypothesis-generating for causality and targeted follow-up.
Long-term neurological and neurodevelopmental sequelae are a concerning issue for people with Enterovirus A71 (EV-A71) central nervous system (CNS) infection. Unfortunately, no longitudinal prospective clinical study has systematically investigated the consequences of EV-A71 CNS infection during early life on the later development of other psychiatric disorders. In this naturalistic longitudinal follow-up design, we followed forty-three youth, who got EV-A71 CNS involvement 6-18 years ago and were enrolled in other EV-A71 clinical studies then. Their psychiatric presentation, emotional/behavioral problems, and cognitive issues were examined using a psychiatrist-conducted diagnostic interview, parent- and self-rated questionnaires, and neuropsychological tests, respectively. We compared the prevalence of psychiatric disorders in youth with EV-A71 CNS involvement to a nationally representative cohort. Emotion/behavior and cognition in EV-A71-CNS-infected youth were compared to those in a matched community-based sample of healthy controls and youth with attention-deficit/hyperactivity disorder (ADHD). Compared to a national sample (absolute ADHD prevalence 10.1%), youth with EV-A71 CNS involvement had three times the odds of receiving an ADHD diagnosis (standardized prevalence ratio, 95% CI = 1.8, 4.2; absolute ADHD prevalence 34.9%). No other psychiatric diagnoses were more common in EV-A71-CNS-infected youth. Compared to community-based ADHD youth, EV-A71-CNS-infected youth with psychiatric disorders showed comparable core ADHD symptoms, opposition/defiance, autistic features, and suboptimal sustained attention performance (based on the Conners' Continuous Performance Test), all of which were more severe than healthy controls. EV-A71-CNS-infected youth without psychiatric disorders showed comparable autistic features to EV-A71-CNS-infected youth with psychiatric disorders and ADHD youth. EV-A71 CNS involvement may cause long-term, adverse psychiatric outcomes that develop into an ADHD diagnosis alongside social/communication/emotion problems and autistic features. We recommend earlier identification and intervention of these problems among these children.
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Lin et al. (2022) conducted a cohort in Enterovirus A71 (EV-A71) central nervous system (CNS) infection (n=43). Enterovirus A71 (EV-A71) central nervous system (CNS) involvement vs. Nationally representative cohort and matched community-based sample was evaluated on ADHD diagnosis (OR 3.0, 95% CI 1.8-4.2). Youth with a history of EV-A71 CNS involvement had three times the odds of receiving an ADHD diagnosis compared to a national sample (34.9% vs 10.1%; 95% CI 1.8-4.2).
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